Provider Demographics
NPI:1497478838
Name:DANDELION SPIRIT PSYCHOTHERAPY, LLC
Entity Type:Organization
Organization Name:DANDELION SPIRIT PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAI
Authorized Official - Middle Name:Y
Authorized Official - Last Name:GUNTY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, PHD
Authorized Official - Phone:651-212-5127
Mailing Address - Street 1:3459 WASHINGTON DR STE 102
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-1388
Mailing Address - Country:US
Mailing Address - Phone:651-212-5127
Mailing Address - Fax:
Practice Address - Street 1:3459 WASHINGTON DR STE 102
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-1388
Practice Address - Country:US
Practice Address - Phone:651-212-5127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty